title: A comperative study between two different surgical techniques in the treatment of late-stage Freiberg's disease.
abstract: BACKGROUND
  The aim was to evaluate the results of two different methods in surgical treatment for patients with late-stage avascular necrosis of the metatarsal head.
  
  
  METHODS
  Between 2007 and 2012, fourteen consecutive patients (13 females, 1 male; mean age 29 yrs; range, 12-58 yrs) with metatarsal head infarction were enrolled for this study. The main presenting symptom was pain on walking or daily activities. According to the Smillie classification all of lesions were classified as in stage IV-V. Six patients had cheilectomy and microfracture procedure in Group A, 8 patients had received cheilectomy and dorsal crescentic osteotomy in Group B. Clinical outcomes were evaluated according to American Orthopaedic Foot and Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal scale and range of motion (ROM) of metatarsophalangeal (MTP) joint. Metatarsal shortening and osteotomy-site healing were evaluated with AP and oblique view X-rays.
  
  
  RESULTS
  The mean follow-up period was 22 months (range, 12-53). The clinical outcomes were excellent in 11(78%) patients and in the 3(22%) patients the results were good. The AOFAS scores increased from a mean of 66.3 points (range, 55-75) preoperatively to 92 points (range, 84-100) at last follow-up in Group A. The mean AOFAS score increased 55.8 points (range, 45-64) to 90.6 points (range, 84-95) in Group B. In the patients that osteotomy have been applied there were no limitation of movement or fixed deformity of the toe.
  
  
  CONCLUSIONS
  These results suggest that both surgical techniques may provide significant improvement in pain and ROM of the MTP joint.
authors.affiliation: Liv Hospital, Istanbul, Turkey. Electronic address: ayhan.kilic@livhospital.com.tr.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Kilic
authors.forename: Kamil Serdar
authors.initials: KS
authors.lastname: Cepni
authors.forename: Ahmet
authors.initials: A
authors.lastname: Aybar
authors.forename: Halil
authors.initials: H
authors.lastname: Polat
authors.forename: Cuneyt
authors.initials: C
authors.lastname: May
authors.forename: Atilla Sancar
authors.initials: AS
authors.lastname: Parmaksizoglu
mesh_terms: D000293:Adolescent; D000328:Adult; D054544:Arthroplasty, Subchondral; D002648:Child; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000473:pathology* / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000601:surgery; D008875:Middle Aged; D010020:Osteonecrosis / Q000145:classification / Q000601:surgery*; D010027:Osteotomy; D010147:Pain Measurement; D063868:Patient Outcome Assessment; D016059:Range of Motion, Articular; D007507:Therapeutic Irrigation; D055815:Young Adult
keywords: Avascular necrosis of the metatarsal head; Cheilectomy; Freiberg's disease; Metatarsal infarction; Microfracture; Osteotomy